Caesarean delivery and neonatal mortality: evidence from selected slums in and around Dhaka city, Bangladesh- A prospective cohort study.

BACKGROUND: This study examined the neonatal mortality for newborn of women who delivered by caesarean section or vaginally using a prospective cohort. METHODS: A total of 6,989 live births registered from 2016 to 2018, were followed for neonatal survival from the selected slums of Dhaka (North and South) and Gazipur city corporations, where icddr,b maintained the Health and Demographic Surveillance System (HDSS). Neonatal mortality was compared by maternal and newborn characteristics and mode of delivery using z-test. Logistic regression model performed for neonatal mortality by mode of delivery controlling selected covariates and reported adjusted odd ratios (aOR) with 95% confidence interval (CI). RESULTS: Out of 6,989 live births registered, 27.7% were caesarean and the rest were vaginal delivery; of these births, 265 neonatal deaths occurred during the follow-up. The neonatal mortality rate was 2.7 times higher (46 vs. 17 per 1,000 births) for vaginal than caesarean delivered. Until 3rd day of life, the mortality rate was very high for both vaginal and caesarean delivered newborn; however, the rate was 24.8 for vaginal and 6.3 per 1,000 live births for caesarean delivered on the 1st day of life. After adjusting the covariates, the odds of neonatal mortality were higher for vaginal than caesarean delivered (aOR: 2.63; 95% CI: 1.82, 3.85). Additionally, the odds were higher for adolescent than elderly adult mother (aOR: 1.60; 95% CI: 1.03, 2.48), for multiple than singleton birth (aOR: 5.40; 95% CI: 2.82, 10.33), for very/moderate (aOR: 5.13; 95% CI: 3.68, 7.15), and late preterm birth (aOR: 1.48; 95% CI: 1.05, 2.08) than term birth; while the odds were lower for girl than boy (aOR: 0.74; 95% CI: 0.58, 0.96), and for 5th wealth quintile than 1st quintile (aOR: 0.59, 95% CI: 0.38, 0.91). CONCLUSION: Our study found that caesarean delivered babies had significantly lower neonatal mortality than vaginal delivered. Therefore, a comprehensive delivery and postnatal care for vaginal births needed a special attention for the slum mothers to ensure the reduction of neonatal mortality.

Antibody longevity and waning following COVID-19 vaccination in a 1-year longitudinal cohort in Bangladesh.

COVID-19 vaccines have been effective in preventing severe illness, hospitalization and death, however, the effectiveness diminishes with time. Here, we evaluated the longevity of antibodies generated by COIVD-19 vaccines and the risk of (re)infection in Bangladeshi population. Adults receiving two doses of AstraZeneca, Pfizer, Moderna or Sinopharm vaccines were enrolled at 2-4 weeks after second dosing and followed-up at 4-monthly interval for 1 year. Data on COVID-like symptoms, confirmed COVID-19 infection, co-morbidities, and receipt of booster dose were collected; blood was collected for measuring spike (S)- and nucleocapsid (N)-specific antibodies. S-specific antibody titers reduced by ~ 50% at 1st follow-up visit and continued to decline unless re-stimulated by booster vaccine dose or (re)infection. Individuals infected between follow-up visits showed significantly lower S-antibody titers at preceding visits compared to the uninfected individuals. Pre-enrolment infection between primary vaccination dosing exhibited 60% and 50% protection against reinfection at 5 and 9 months, respectively. mRNA vaccines provided highest odds of protection from (re)infection up to 5 months (Odds Ratio (OR) = 0.08), however, protection persisted for 9 months in AstraZeneca vaccine recipients (OR = 0.06). In conclusion, vaccine-mediated protection from (re)infection is partially linked to elevated levels of S-specific antibodies. AstraZeneca vaccine provided the longest protection.

Preterm birth and neonatal mortality in selected slums in and around Dhaka City of Bangladesh: A cohort study.

BACKGROUND: Although under-five mortality has declined appreciably in Bangladesh over the last few decades, neonatal mortality still remains high. The objective of the study is to assess the level and determinants of preterm birth and the contribution of preterm birth to neonatal mortality. METHODS: Data for this study came from selected slums in and around Dhaka city, where; since 2015, icddr,b has been maintaining the Health and Demographic Surveillance System (HDSS). The HDSS data were collected by female Field Workers by visiting each household every three months; however, during the visit, data on the Last Menstrual Period (LMP) were also collected by asking each eligible woman to ascertain the date of conception. Gestational age was estimated in complete weeks by subtracting LMP from the date of the pregnancy outcome. In this study, 6,989 livebirths were recorded by HDSS during 2016-2018, and these births were followed for neonatal survival; both bivariate and multivariate analyses were performed. RESULTS: Out of total births, 21.7% were born preterm (before 37 weeks of gestation), and sub-categories were: 2.19% for very preterm (28 to 31 weeks), 3.81% for moderate preterm (32 to 33 weeks), and 15.71% for late preterm (34 to 36 weeks). The study revealed that preterm babies contributed to 39.6% of neonatal deaths; however, the probability of death was very high on the 1st day of birth (0.124 for very preterm, 0.048 for moderate preterm, 0.024 for late preterm, and 0.013 for term birth), and continued until the 3rd day. In the regression analysis, compared to the term neonates, the odds of neonatal mortality were 8.66 (CI: 5.63, 13.32, p<0.01), 4.13 (CI: 2.69, 6.34, p<0.01) and 1.48 (CI: 1.05, 2.08, p<0.05) respectively for very, moderate, and late preterm birth categories. The population attributable fraction for neonatal mortality was 23%, and sub-categories were 14% for very preterm, 10% for moderate preterm, and 6% for late preterm. CONCLUSIONS: Although urban slums are in proximity to many health facilities, a substantial proportion of preterm births contribute to neonatal deaths. So, pregnant women should be targeted, to ensure timely care during pregnancy, delivery, and post-partum periods to improve the survival of new-borns in general and preterm birth in particular.

Serosurveillance among urban slum and non-slum populations immunized with COVID-19 vaccines in Bangladesh.

Using two rounds of serosurveillance, we aimed to observe the COVID-19 vaccination status and the dynamics of antibody responses to different vaccines among urban slum and non-slum populations of Bangladesh. Adults (>18 years) and children (10-17 years) were enrolled in March and October 2022. Data including COVID-19 vaccine types and dosage uptake were collected. SARS-CoV-2 spike (S)-specific antibodies were measured in blood. The proportion of vaccinated children was significantly lower among slum than non-slum populations. Two doses of vaccines showed an increase in the level of anti-S-antibodies up to 2 months, followed by reduced levels at 2-6 months and a resurgence at 6-12 months. Children showed significantly higher anti-S-antibodies after two doses of the Pfizer-BioNTech vaccine than adults; however, after 6 months, the level of antibodies declined in younger children (10 - < 12 years). In a mixed vaccine approach, mRNA vaccines contributed to the highest antibody response whether given as the first two doses or as the third dose. Our findings emphasized the need for increasing the coverage of COVID-19 vaccination among slum children and booster dosing among all children. The use of mRNA vaccines in the mixed vaccination approach was found to be useful in boosting the antibody response to SARS-CoV-2.

Beyond the regulatory radar: knowledge and practices of rural medical practitioners in Bangladesh.

BACKGROUND: Informal and unregulated rural medical practitioners (RMPs) provide healthcare services to about two-thirds of people in Bangladesh, although their service is assumed to be substandard by qualified providers. As the RMPs are embedded in the local community and provide low-cost services, their practice pattern demands investigation to identify the shortfalls and design effective strategies to ameliorate the service. METHODS: We conducted a cross-sectional study in 2015-16 using a convenient sample from all 64 districts of Bangladesh. Personnel practising modern medicine, without any recognized training, or with recognized training but practising outside their defined roles, and without any regulatory oversight were invited to take part in the study. Appropriateness of the diagnosis and the rationality of antibiotic and other drug use were measured as per the Integrated Management of Childhood Illness guideline. RESULTS: We invited 1004 RMPs, of whom 877 consented. Among them, 656 (74.8%) RMPs owned a drugstore, 706 (78.2%) had formal education below higher secondary level, and 844 (96.2%) had informal training outside regulatory oversight during or after induction into the profession. The most common diseases encountered by them were common cold, pneumonia, and diarrhoea. 583 (66.5%) RMPs did not dispense any antibiotic for common cold symptoms. 59 (6.7%) and 64 (7.3%) of them could identify all main symptoms of pneumonia and diarrhoea, respectively. In pneumonia, 28 (3.2%) RMPs dispensed amoxicillin as first-line treatment, 819 (93.4%) dispensed different antibiotics including ceftriaxone, 721 (82.2%) dispensed salbutamol, and 278 (31.7%) dispensed steroid. In diarrhoea, 824 (94.0%) RMPs dispensed antibiotic, 937 (95.4%) dispensed ORS, 709 (80.8%) dispensed antiprotozoal, and 15 (1.7%) refrained from dispensing antibiotic and antiprotozoal together. CONCLUSIONS: Inappropriate diagnoses, irrational use of antibiotics and other drugs, and polypharmacy were observed in the practising pattern of RMPs. The government and other stakeholders should acknowledge them as crucial partners in the healthcare sector and consider ways to incorporate them into curative and preventive care.

Factors Associated with Reported COVID-like Symptoms and Seroprevalence Data Matched with COVID-like Symptoms in Slums and Non-Slums of Two Major Cities in Bangladesh.

OBJECTIVES: To examine the levels and socio-demographic differentials of: (a) reported COVID-like symptoms; and (b) seroprevalence data matched with COVID-like symptoms. METHODS: Survey data of reported COVID-like symptoms and seroprevalence were assessed by Roche Elecsys® Anti-SARS-CoV-2 immunoassay. Survey data of 10,050 individuals for COVID-like symptoms and seroprevalence data of 3205 individuals matched with COVID-like symptoms were analyzed using bivariate and multivariate logistic analysis. RESULTS: The odds of COVID-like symptoms were significantly higher for Chattogram city, for non-slum, people having longer years of schooling, working class, income-affected households, while for households with higher income had lower odd. The odds of matched seroprevalence and COVID-like symptoms were higher for non-slum, people having longer years of schooling, and for working class. Out of the seropositive cases, 37.77% were symptomatic-seropositive, and 62.23% were asymptomatic, while out of seronegative cases, 68.96% had no COVID-like symptoms. CONCLUSIONS: Collecting community-based seroprevalence data is important to assess the extent of exposure and to initiate mitigation and awareness programs to reduce COVID-19 burden.

Lead in traditional and complementary medicine: a systematic review.

Lead in the environment remains a matter of grave concern for public health. Lead has been associated with some traditional medicines and has been linked to cases of lead poisoning. A comprehensive compilation of these reports has not previously been conducted. The objective of this review is to explore how common is lead exposure after traditional medicine use, and which countries, systems and/or products are of most concern when it comes to lead contamination. A systematic search was conducted on PubMed, Ovid and EMBASE for studies published between 2005 and 2020. A grey literature search was conducted. Search terms related to lead and traditional medicine were developed for each database, and there were no limitations on language. Studies were included if they examined elevated lead in humans resulting from the use of traditional medicines reported in case reports, case-series, or observational studies. Of the papers discussing lead exposure, 85 case reports were identified and synthesized for the current review. Several themes were identified in the included studies. Traditional medicine has been used in the many parts of the world, however use is more common in South and Southeast Asian countries. The level of detectable lead in products varied widely by region and product types. Consumers of traditional medicines sought products for a wide variety of symptoms and ailments. The symptoms of lead poisoning from traditional medicine use reflected the typical symptom profile of lead poisoning, highlighting the need for awareness of traditional medicine products as a source of lead exposure. Traditional medicine usage remains an important part of health care in many regions, however there is a risk of lead exposure from several products. Health care practitioners in all regions of the world should be aware of the risk and explore the potential for traditional medicine use for patients presenting with elevated blood lead levels. Countries with a strong traditional medicine culture should explore policies for reducing lead exposure from traditional medicine products. JG, LO and MNBD are staff members of the World Health Organization. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions, policy, or views of the World Health Organization.

Bioactive Compounds and Quality Evaluation of Red-Pigmented Rice Processed by Germination and Roasting.

Red-pigmented rice was germinated and processed to develop germinated red rice tea, and the changes in physicochemical, bioactive, and microbial properties due to germination and roasting were investigated. The moisture and crude ash contents of red rice decreased after germination and roasting. Crude protein and crude fat contents increased after germination but slightly decreased after roasting. Total phenolics, flavonoids, and antioxidant activities (DPPH and ABTS radical scavenging activities) increased following germination and heat treatment. However, the increased levels of γ-amino butyric acid after germination significantly decreased during the subsequent roasting step. In addition, total bacteria, yeast, and mold counts increased during the germination process but decreased after heat treatment as compared to those in the original grain; Escherichia coli was not detected. Therefore, germination and subsequent roasting could effectively enhance the contents of the most bioactive compounds and maintain microbial stability in red-pigmented rice.

Levels, trends and socio-demographic determinants of infant and under-five mortalities in and around slum areas of Dhaka city, Bangladesh.

Infant and child mortality are often used to monitor the progress of national population health programs. The data for this study was collected from selected urban slums where icddr,b has maintained the Health and Demographic Surveillance System (HDSS). Using the HDSS database, 6,666 married women were selected and interviewed in 2018 to collect data on socioeconomic status, pregnancy history and safe motherhood practices. The study examined levels and trends of infant and under-five mortality for three periods: 1990-1999 (Period 1), 2000-2009 (Period 2), and 2010-2018 (Period 3) and examined socio-demographic differentials of infant and under-five mortality for Period 3. From Period 1 to Period 3, under-five mortality declined by 68.2%, with child mortality (1-4 years) declining more than infant mortality (84% vs. 65%). In the regression models for Period 3, infant and under-five mortality were higher for working than non-working mothers (infant: OR = 1.35*, CI: 0.98, 1.86; under-five: OR = 1.34*, CI: 0.99, 1.82), lower for girls than boys (infant: OR = 0.77*, CI: 0.57, 1.03; under-five: OR = 0.77*, CI: 0.58, 1.03), higher for small-size than normal/big-size babies (infant: OR = 4.11***, CI: 3.00, 5.64; under-five: OR = 3.68***, CI: 2.70, 5.02), higher for babies delivered vaginally than by caesarean section (infant: OR = 1.79**, CI: 1.14, 2.97; under-five: OR = 1.87***, CI: 1.21, 2.88), higher for babies delivered with complications than no complication (infant: OR = 2.16***, CI: 1.48, 3.15; under-five: OR = 2.21***, CI: 1.55, 3.18), and higher for babies born after a short (<24 months) birth interval (infant: OR = 1.71*, CI: 0.96, 3.05; under-five: OR = 1.63*, CI: 0.93, 2.86) than firstborns. While substantial progress has been made in reducing under-five and infant mortality, neonatal mortality have declined less slowly. Targeted population health interventions addressing the socio-demographic drivers of infant mortality, with a focus on the urban poor, will help Bangladesh achieve Sustainable Development Goal 3.

Assessment of biochemical compounds and antioxidant enzyme activity in barley and wheatgrass under water-deficit condition.

Wheatgrass and barley grass are freshly sprouted leaves of wheat and barley seeds and are rich sources of phytochemicals. This study was conducted to investigate the effects of drought stress on the biochemical compounds and antioxidant activities of barley grass and wheatgrass extracts. The grass was cultivated in an organic soil growing medium with different levels of drought stress (a control with 100% water holding capacity (WHC), mild drought stress with 75% WHC, moderate drought stress with 50% WHC, and severe drought stress with 25% WHC) in a growth chamber by controlling temperature (20/15 °C, day/night), light (12/12 h, light/dark; intensity 150 µmol m-2  s-1 with quantum dot light-emitting diodes), and relative humidity (60%) for 7 days. The drought stress showed increased levels of biochemical compounds, especially phenolics, flavonoids, and vitamin C, in both barley grass and wheatgrass extracts. The wheatgrass extracts showed 1.38-1.67 times higher phenolics, flavonoids, and vitamin C contents than the barley grass extracts did. The antioxidant (2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid), 2,2-diphenyl-1-picrylhydrazyl radical-scavenging activity, and nitrite-scavenging activity) and antioxidant enzymes (guaiacol peroxidase, catalase, and glutathione reductase) were the highest under severe drought stress in both barley grass and wheatgrass extracts; and the wheatgrass extracts showed 1.20-5.70 times higher antioxidant enzyme activities than the barley grass extracts did. Proper drought-stress treatment of barley grass and wheatgrass may be a convenient and efficient method to increase biochemical compounds and antioxidants in our diet to exploit the related health benefits. © 2021 Society of Chemical Industry.

Influence of Temperature Conditions during Growth on Bioactive Compounds and Antioxidant Potential of Wheat and Barley Grasses.

Wheat and barley grasses are freshly sprouted leaves of wheat and barley seeds, and are rich sources of phytochemicals. This study was conducted to investigate the effects of day and night temperatures on the growth, bioactive compounds, and antioxidant potential of wheat and barley grasses. Briefly, each grass was cropped in an organic growing medium at 10/5 °C, 20/15 °C, and 30/25 °C (day/night temperature) in a growth chamber by maintaining specific light (12/12 h light/dark; light intensity 150 µmol photons m-2 s-1) and humidity (60%) conditions for 8 days. The highest growth parameters (height, weight, and yield) were observed at the 20/15 °C growth conditions in both types of grass. Conversely, the lowest growth parameters were observed at 10/5 °C. However, the low growth temperature of 10/5 °C resulted in increased levels of bioactive compounds (total phenol, total flavonoid, and total vitamin C), antioxidant activities (2,2'-azino-bis (3-ethylbenzothiazoline-6-sulphonic acid and 2,2-Diphenyl-1-picrylhydrazyl radical-scavenging activity)), and antioxidant enzymes (guaiacol peroxidase activity, catalase activity, and glutathione reductase) in both types of grass. Therefore, proper temperature growth conditions of wheat and barley grasses may be a convenient and efficient method to increase bioactive compounds and antioxidant potential in our diet to exploit the related health benefits.

Physicochemical and bioactive properties of a high ß-glucan barley variety 'Betaone' affected by germination processing.

This study was conducted to investigate the effects of germination on the bioactive phytochemicals in the barley variety 'Betaone', which has high ß-glucan content. Betaone barley seeds were germinated for 24, 48, 72, and 96 h at 25 °C in a growth chamber. As the germination period progressed, crude protein, crude fat, and crude ash levels increased, while starch content decreased. ß-Glucan content significantly decreased during the germination period. However, after 96 h of germination, it was still 4.31%, which is similar to the amount found in ordinary barley varieties. The α- and ß-amylase activities in Betaone barley increased, thereby significantly decreasing pasting viscosities (p ≤ 0.05), as germination progressed. The water absorption index increased in the early germination stage, subsequently decreasing as germination progressed. While the water solubility index fell in the first stage of germination, it subsequently increased as germination progressed. Oil absorption decreased as germination progressed. Bioactive compounds, in particular the total phenolic (122.84-322.67 µg/g), total flavonoid (32.20-124.09 µg/g), and GABA content (176.94-212.64 µg/g), increased as germination progressed. The antioxidative properties mainly DPPH and ABTS radical scavenging activity also increased during the germination period. Therefore, these findings could be a useful method for improving new products with enhanced bioactive phytochemicals.

Consumer Preference, Quality, and Safety of Organic and Conventional Fresh Fruits, Vegetables, and Cereals.

Growing and purchasing demand for organic fresh produce is increasing rapidly. Consumers are aware of health, environmental safety, pesticide harmfulness, nutrients, bioactive compounds, and safe food. Many research works are available on organic and conventional fresh produce. As organic fresh produce growing and purchasing demand is increasing, it has become necessary to review the recent trends in quality, safety, and consumer preferences of organic and conventional fresh food products. A few reports have been compiled on organic and conventional fresh produce. Researchers have started working on organic and conventional fresh produce with the help of modern technology to improve nutritional and functional quality, safety, and consumer preferences. Nutritional and functional quality, safety, and consumer preferences depend on cultivation techniques, treatment, crop cultivar, and appearance of products. Therefore, it is necessary to compile the literature on organic and conventional fresh produce based on quality, safety, and consumer preferences.

Grape terpenoids: flavor importance, genetic regulation, and future potential.

Terpenes significantly affect the flavor and quality of grapes and wine. This review summarizes recent research on terpenoids with regard to grape wine. Although, the grapevine terpene synthase gene family is the largest identified, genetic modifications involving terpenes to improve wine flavor have received little attention. Key enzyme modulation alters metabolite production. Over the last decade, the heterologous manipulation of grape glycosidase has been used to alter terpenoids, and cytochrome P450s may affect terpene synthesis. Metabolic and genetic engineering can further modify terpenoid metabolism, while using transgenic grapevines (trait transfer to the plant) could yield more flavorful wine. We also discuss traits involved in wine aroma quality, and the strategies that can be used to improve grapevine breeding technology.

Green space and early childhood development: a systematic review.

Background The urban environment presents significant health challenges for children, such as discouraging physical exercise and increasing exposure to air pollution, excessive noise and higher temperatures. Reducing exposures to these negative environmental factors can have great benefits on a child's well-being and lower their risk of developing chronic diseases later in life. There is increasing evidence that suggests that the presence of urban green space can offer benefits to human health and well-being. While studies have reported the impact green space exposure has on the individual health outcomes of children, few have paid attention to the link between green space and the child's development. This review aims to synthesise the evidence of the effect green space exposure has on early childhood development. Objectives To explore the relationship between green space and early childhood development. Methods An online search was conducted using pre-identified keywords related to green space and early childhood development using search engines such as PubMed, MEDLINE, Web of Science, MeSH and PsycINFO. Peer-reviewed papers published in the past 10 years were included in this review. Papers were selected, extracted, analysed and interpreted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Fifty-one papers were identified, of which 28 were excluded due to duplications or irrelevance, yielding a total of 23 papers to be reviewed. Articles were categorised based on reported outcomes: perinatal health, physical health, psychological health and respiratory health. An increase in green space during pregnancy was associated with increased birth weight and a decreased risk for low birth weight (LBW). Further, higher greenness exposure during childhood was associated with increased levels of physical activity and a lower risk of obesity and neurodevelopmental issues such as inattentiveness. While green space exposure was negatively associated with wheezing and bronchitis in some cohorts, certain plant species increase asthmatic symptoms during childhood, indicating that plant species type is an important determinant. Conclusion The extant literature on green space exposure and early childhood development is small. Regardless, the existing research provides promising insights into the benefits of green space exposure on children's health and well-being in an ever-increasing urban world. Further research is needed on the causal relationships between both quantity and quality of green space to early childhood development.

Correction to: Association of Time since Migration from Rural to Urban Slums and Maternal and Child Outcomes: Dhaka (North and South) and Gazipur City Corporations.

There is an error in Fig 2 in this article: There should not be a box indicating p-values.

Influence of selenium biofortification on the bioactive compounds and antioxidant activity of wheat microgreen extract.

The study was conducted to confirm the effects of selenium biofortification on the bioactive compounds and antioxidant activity of wheat microgreen extract. The microgreens were cultivated in the DFT hydroponic system with different concentrations of Se (0 [control], 0.125, 0.25, 0.50, and 1.00 mg/L from sodium selenite) in a growth chamber by controlling temperature (25/20 °C, day/night), light (12 h light/dark; intensity 150 µmol‧m-2‧s-1 with white fluorescence lamp), and humidity (60%) for 10 days. Se biofortification increased the germination rate and decreased microgreen length and yield. Chlorophyll and carotenoid levels increased in the Se-biofortified microgreen extract. Bioactive compounds such as phenolics, flavonoids, vitamin C, and anthocyanin significantly increased in 0.25-0.50 mg/L of Se-biofortified microgreen extracts. Antioxidant (ABTS, DPPH, NSA and SOD-like) activity also increased at moderate levels (0.25-0.50 mg/L) of Se biofortification. Therefore, Se biofortification may be useful for the industrial manufacture of new products from wheat microgreen extract.

Association of Time since Migration from Rural to Urban Slums and Maternal and Child Outcomes: Dhaka (North and South) and Gazipur City Corporations.

This study analyzes data from a new Urban Health and Demographic Surveillance (UHDSS) in five slums in Dhaka (North and South) and Gazipur City Corporations to examine the relationship between migration status and maternal and child health service utilization. Migration status was determined by duration in urban slums (<= 9.99 years, 10-19.99 years, 20+ years, and urban-born). Compared to those born in the city, migrants were characterized by significant disadvantages in every maternal, neonatal, and child health (MNCH) indicator under study, including antenatal care, facility-based delivery, doctor-assisted delivery, child immunization, caesarean-section delivery, and use of modern contraceptives. We found that the level of service coverage among migrants gradually converged-but did not fully converge-to that of the urban-born with increasing duration in the city. We observed a strong positive association between wealth and total MNCH coverage, with a more modest association with higher levels of schooling attainment. Women who were engaged in market employment were less likely to receive adequate coverage, suggesting a tradeoff between livelihood attainment and mother-and-child health. After controlling for these socioeconomic and neighborhood variations in coverage, the duration gradient was diminished but still significant. In line with existing studies of healthcare access, this study highlights the persistent and widespread burden of unequal access to maternal and child health care facing migrants to slum areas, even relative to the overall disadvantages experienced in informal settlements.